| NPI | 1376975466 |
|---|---|
| Former Name | STEPHANIE JEAN NICOLA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 2246) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9909) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2016-03-04 |